A critical discussion of evidence for access to trauma counselling for mothers of preterm infants to improve infant wellbeing

This article will critically discuss whether treating the mother; as well as parents' mental health following preterm birth, might reduce infant stress and improve overall infant wellbeing. The World Health Organisation define preterm birth by gestational age (GA); with births occurring >32 weeks' GA regarded as 'very preterm'; 32-37 weeks' GA 'moderate to late preterm'; and births following 37 weeks' completed gestation are regarded as 'term' (World Health Organisation, 2018).

Mothers of preterm infants, when compared to mothers of term infants, carry a greater risk of developing adverse mental health conditions such as depression, anxiety, and symptoms of post-traumatic stress disorder (PTSD) (e.g., Beck & Harrison, 2017; Eutrope et al., 2014; Gondwe & Holditch-Davis, 2015; Grekin & O'Hara, 2014; Petit et al., 2016). Two weeks following preterm birth, 52% of mothers suffered PTSD symptoms; 28% depression and 17% anxiety (Misund et al., 2016).

All of which might have an adverse effect on the mother's ability to cope as well as infant attachment (Brisch et al., 2003). It has been suggested that only 20% of mothers with preterm infants developed a secure attachment to their infant at six months, compared to 53% of mothers of term infants (Borghini et al., 2006). However, promoting better coping mechanisms to parents of preterm infants have shown improved attachment bond and improved parent-infant interaction (Brisch et al., 2003).

Maternal depression may also act as a potential stressor for the infant; Bugental et al. (2008) measured hormonal sensitivity in preterm as well as term infants with mothers suffering from maternal depression. The infant's cortisol levels were measured, and comparisons made between the two cohorts. The results showed preterm infants presented lower cortisol levels when paired with non-depressed mothers and higher cortisol levels when paired with depressed mothers; these effects were not found in term infants, even if other medical problems had been experienced at birth.

Children born preterm are also at increased risk of cognitive and behavioural problems (Bhutta et al., 2002) with parents' poor mental wellbeing seen as a further risk-factor for children's social, emotional, cognitive, and physical development (Beck, 1995). Survival rate of preterm infants is estimated at around 78% to 93% (Helenius et al., 2017), as this increases, so does the need to understand the factors leading to poor mental health in their parents (Winter et al., 2018).

Trauma focused Cognitive Behavioural Therapy (CBT) interventions have shown significant reduction in depression and trauma symptoms in parents of preterm infants (Jotzo & Poets, 2005). Previous intervention programs have focused on individual delivery (e.g. Shaw et al., 2014) whereas, Simon et al. (2021) conducted 'trauma-focused group-based therapy'. The group therapy was aimed at reducing or preventing anxiety, depression, and PTSD symptoms over time in a group of mothers with preterm infants.

Symptoms were measured at baseline; six weeks and six months and it was found that symptoms of anxiety had been reduced from moderate to mild anxiety by six months; depression significantly reduced from 'borderline clinical depression' to 'mild mood disturbance' by six weeks; and symptoms of trauma also significantly reduced by six months. Group delivery added further benefits with mothers feeling supported and understood by other group members. This is encouraging but it should be noted that small sample size might present a limitation to this study and further studies might wish to evaluate the effect of the group intervention in a larger sample to assess overall symptom reduction.

Group delivery of trauma focused intervention might, in addition to addressing symptom reduction (Jotzo & Poets, 2005), expand access to mental health provision to a wider group of mothers following preterm birth and reduce the burden on mental health provision within the NICU setting (Simon et al., 2021). Further research might also wish to explore the effectiveness of online delivery of such intervention, which might further expand access to treatment and reduction in cost, when compared to traditional face-to-face interventions (Colditz et al., 2019).

Group CBT intervention might therefore prove effective in treating mothers following preterm birth, furthermore this could help improve overall infant wellbeing and reduce infant stress. This is particularly important as children born preterm already have an increased risk of poor developmental outcomes without the additional risk that poor maternal wellbeing may add to this.

Emma Lewis is a final year BSc. (Hons) Psychology and Child Development student with particular interest in the psychological effects surrounding preterm birth; from mental health and support for mothers and parents, to developmental outcomes of infants and children born preterm.